Practice Management Channel

4 Ways to Improve Services for Young Children in Your Office

By Lindsay Berry, OD

Jan. 29, 2020

Families with children are a great source of growth for most practices. The whole family coming in for care means more services provided, and more products sold, and seeing children as patients means many will stick with you when they become adults. With so much to gain, it’s worth considering: What do your young children patients need to be comfortable and well-served while in your office?

This question is especially pressing to me, as I am a new mother, who works in a practice focused on neuro-rehabilitative care and vision therapy.

Keep Kids Happily Occupied While They Wait
Our office has a designated play area for children in the waiting room. The play area consists of books and toys appropriate for a range of ages. Toys include blocks, wooden puzzles, toy cars and an Xbox video game system. It is useful to have some activities that can be done quickly (i.e. blocks, short books), and others that can occupy a sibling for longer (i.e. a puzzle or coloring pages).

Children do not require much furniture since most are comfortable playing on the floor. However, having a small table with a few chairs is good for activities like coloring and reading. This usually costs around $50-$100 depending on the set. I’d recommend something that can be cleaned and wiped down daily since kids spread germs easily. Having the play area carpeted is also important since kids will play on the floor.

Manage Child & Parent to Get Needed Information
I have most children sit “cross-cross applesauce” in the exam chair to keep them from slouching or wiggling too much. I have them sit on their knees if they are too short to put their chin in the slit lamp. We also have a television in the exam room that can play YouTube videos to keep children’s attention during retinoscopy and while they are dilating.

We allot the same amount of time for a pediatric wellness exam as an adult wellness exam. We schedule 30 minutes for these exams, which allows for time to discuss academic performance and conduct a few screening tests of binocular skills such as Cover Test, NPC, Pursuits/Saccades and MEM.

Most parents are understanding of the fact that reliable information needs to be obtained from the patient without their help. However, there are some parents who offer help or hints to children. In these cases I often will say: “I understand that you are trying to offer help, but I’d like to see if Jane can do this on her own. I need the information from her only in order to determine the best treatment plan.”

If the parent still seems hesitant I will add: “I appreciate your desire to help. I’d love for you to help during another part of the exam in a little bit.” I will then have the parent help position the child and help keep their head in place during the slit lamp examination. It is important to respect each parent, but also work with them to obtain accurate test results.

Address Child Directly & Explain What You’re Doing
I always address the child first. They are the patient and they need to know that they are the focus during the exam. I then introduce myself to the parents. When performing exam testing, I always address the child and only involve the parent if cooperation from the child is really poor.

At the end of the exam I always tell the child that I will be speaking with their parent to tell them about their eyes. I also tell them that if they are quiet while we speak, then they can pick a prize when we have finished. Children deserve the same respect that we would show an adult. Including them in conversations and involving them in their care is important and makes them active participants in their eyecare.

A quick explanation of the tests being done is helpful for some children. Children who are nervous or apprehensive about the exam often cooperate much better when tests are explained. Some children do not care at all about the testing, but quick explanations with them are still helpful to try to get them more engaged during testing.

Some are curious about the instruments and testing, so I try to address any questions they have in a way they can understand. Young children continue to surprise me in what they are thinking about and how much they already know about eyes and vision.

Calm Anxious & Hyperactive Children
Working with anxious children can be stressful and frustrating at times, especially when you have limited exam time. What I find helpful is getting the child to talk about something they enjoy. I will squat down to their eye level (or raise the chair to my eye level if they are sitting) when speaking with them so they are not intimidated.

I often start the conversation by asking them their name, their age and their favorite game or toy. I often transition into the exam like this: “Wow, I love to play hide and go seek, too. Can we play a few of my eye games? You can get a prize at the end if you win!” Changing your language from “tests” or “procedures” to “games” or “competitions” can be extremely helpful to calm an anxious child.

When working with hyperactive children it is important to work quickly! You often only get one attempt to complete a test, so it is important to make each effort worth while. It also helps to be prepared and organized. I find it helpful to have all testing materials and equipment readily available and within arms-reach.

Hyperactive children also pay attention better when you involve them in the testing. For example, during the cover test I will have them hold the fixation target or when performing retinoscopy I will have them read the chart instead of just looking at it.

 

Lindsay Berry, OD, is an associate at Neuro-Vision Associates of North Texas. To contact her: dr-berry@dr-s.net

 

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